Key Contacts: Marie Kinsella – Partner | Anne Bateman – Partner | Alison Murray – Partner |
Ireland is preparing for the most significant transformation of its mental health legislation in more than two decades. The Mental Health Bill 2024 (the “Bill”) introduces a comprehensive new statutory framework that will fundamentally change how mental health services operate across registered acute mental health centres and registered community mental health centres/services.
The Bill, now through Seanad Committee Stage, reflects a shift toward a rights‑centred, capacity‑focused approach to mental health care. It expands the scope of regulated services, strengthens procedural protections for individuals accessing care, and places additional obligations on providers in relation to assessment, consent, restrictive practices, record‑keeping, and governance. In practical terms, this means healthcare organisations will need to review and, in many cases, redesign their existing clinical and operational processes.
Providers should now begin preparing for implementation to ensure continuity of compliance once commencement occurs.
A Rights‑Centred Framework
The Bill moves decisively away from the “best interests” model underpinning the Mental Health Act 2001. For adults, decisions must instead be grounded in capacity, will and preferences, dignity, autonomy, and the principle of least restriction. Adults will be presumed to have capacity unless assessed otherwise, consistent with the framework established by the Assisted Decision‑Making (Capacity) Act 2015.
For children, the best‑interests standard remains central, but the Bill places significantly greater emphasis on the child’s own views and preferences. 16 and 17 year olds with capacity will now have legal standing to consent to, or refuse, mental health treatment. This represents a material change to clinical engagement and documentation obligations relating to this age group.
Where a person lacks capacity and declines treatment, practitioners will also need to follow revised statutory pathways, including circumstances in which applications to the courts may be required.
Involuntary Admission
The Bill introduces a more detailed and structured framework for involuntary admission. It clarifies the definition of mental disorder, sets out more precise thresholds relating to immediate and serious harm, and requires that any admission provides therapeutic benefit.
A notable operational change is the removal of Gardaí from most application routes. Instead, Authorised Officers will assume a central role, which will have implications for staffing, availability, and coordination. The Bill also introduces clearer statutory timelines for assessments and Mental Health Review Board reviews, alongside new requirements to provide written information to individuals and their nominated persons.
These changes collectively create a more procedurally robust pathway, but one that will require providers to adjust internal workflows and ensure that staff are trained and familiar with the revised processes.
Consent to Treatment
The Bill significantly reshapes the legal framework governing consent. Where a person is assessed as lacking capacity, that assessment must be reviewed at least every 14 days. If no advance healthcare directive or decision‑making representative covers the proposed treatment, certain interventions will require Circuit Court approval.
Electro‑convulsive therapy (ECT) is subject to an elevated statutory threshold. Written consent will be required unless the person lacks capacity, and even then, the safeguards governing its use are extensive.
These provisions will require services to adopt more structured capacity‑assessment procedures, introduce new escalation pathways, and review internal documentation and governance processes.
Children and Adolescent Mental Health
Part 4 of the Bill sets out a comprehensive statutory regime for children and adolescents. Capacity‑based decision‑making for 16 and 17 year olds marks a substantial shift and aligns mental health decision‑making for this cohort with physical healthcare rights.
The Bill also updates the criteria for voluntary and involuntary admission of children and strengthens entitlements relating to information, participation in meetings, and access to review.
Restrictive practice provisions for children include additional safeguards reflecting age, size, vulnerability, and individual needs. New regulatory standards for CAMHS are expected ahead of commencement, and providers will need to plan for their integration.
Restrictive Practices
The Bill introduces a rigorous statutory framework governing the use of seclusion, mechanical restraint, and physical restraint. These practices may be used only as a last resort, for the shortest possible time, and where no safer alternative exists.
Each use must be recorded in a prescribed manner, included in the medical record, and notified to the Mental Health Commission (“MHC”). The MHC will also have extensive regulation‑making powers, which are expected to introduce detailed requirements for policy, documentation, monitoring, and staff training.
The overall effect is to increase accountability and oversight in an area of high clinical and legal sensitivity.
Expanded Commission Powers and Mandatory Registration
For the first time, all mental health services, including acute, residential, community, and CAMHS, will fall under a uniform system of registration, regulation, and inspection by the Mental Health Commission. Providers will be required to display registration certificates, prepare care plans within strict timelines, maintain enhanced records, and respond promptly to compliance notices.
A broad package of accompanying amendments has been developed to support this expanded regulatory approach, and services should expect a more prescriptive and closely monitored environment.
Conclusion
The scale of reform introduced by the Bill means that mental health providers will be operating within a substantially different legal environment once the legislation is commenced. Preparing early will allow organisations to transition smoothly, minimise disruption, and ensure that clinical and operational practices remain aligned with statutory expectations. The coming months provide an opportunity to review internal processes, strengthen governance structures, and build the capacity needed to operate confidently under the new framework. Taking these steps now will support compliance, enhance quality of care, and position providers for a more regulated and rights‑centred mental health landscape.
For further information, please contact Marie Kinsella, Anne Bateman, Alison Murray on our Healthcare team.
